Inspection on 23/03/07 for Garrett House Residential Home

This inspection was carried out on 23rd March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Garrett House Residential Home 27/08/08

Garrett House Residential Home 19/12/07

Garrett House Residential Home 08/02/06

Garrett House Residential Home 25/08/05

Garrett House Residential Home 18/02/05

Garrett House Residential Home 01/07/04

Garrett House Residential Home 09/10/03

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Garrett House Residential Home 43 Park Road Aldeburgh Suffolk IP15 5EN Lead Inspector Joe Staines Unannounced Inspection 23rd March 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garrett House Residential Home Address 43 Park Road Aldeburgh Suffolk IP15 5EN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01728 453249 01728 451730 Mrs W Stedman Mr B Stedman Mrs W Stedman Care Home 45 Category(ies) of Dementia (6), Old age, not falling within any registration, with number other category (39) of places Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th February 2006 Brief Description of the Service: Garrett House is a large Georgian house, which has been in use as a care home for older people since 1982. The Home is located on a private road within a residential setting in the costal town of Aldeburgh. It is situated in grounds of approximately four acres of landscaped gardens, which incorporate a croquet lawn, tropical themed courtyard, a summerhouse and a fenced pond. The House has views to the river Alde. The main house and extension offer accommodation on two floors. There is a passenger lift serving both sides of the Home. Most of the bedrooms are single, seventeen of which providing very spacious accommodation, with two larger bedrooms available should couples wish to share. Within these numbers the home offers four suites incorporating adjoining rooms and exceeding the standards for accommodation. All the bedrooms in the extension have en suite facilities, as do many in the main house. As a result of recent developments, the home now has four new rooms, and has increased its capacity from 41 to 45 service users. Further developments to create additional space are currently being considered by the owners. Garrett House is registered under the Care standards Act 2000 as a Care Home to accommodate up to 45 older persons, including 6 individuals with dementia. Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced. The registered manager was away at the time and had previously informed The Commission for Social Care Inspection of this. Senior care and administrative staff were present throughout the inspection and were able to access and provide all the required documentation. The inspection took place on a weekday between 10.30 and 14.30. The home was warm and residents were appropriately dressed. During the course of the inspection four residents’ pre admission assessments and care plans were viewed, along with daily notes. Three new staff files were examined, along with various records and policies including financial records, complaints and compliments records, staff training records, menus, the medication policy, maintenance records, staff rotas and quality assurance materials were all seen. A brief tour of the home was undertaken, and a number of staff and residents were spoken with. The administrator explained the system used to manage the residents’ personal money. On the day of inspection the home was clean and tidy. Staff were responding appropriately to residents’ needs and conversation between staff and residents was cheerful and caring. The lunchtime meal served looked hot and appetising and residents said they enjoyed the food tremendously. What the service does well: The environment and facilities at Garrett House are of the highest standard, and are beautifully maintained both internally and externally. Examples of the comments made by service users include: “It’s wonderful here”, “I couldn’t be better cared for in a hotel” and ”I’m well cared for here”. At this inspection, evidence was seen of good practice in relation to pressure care and continence care. The overall package of care has been the subject of complimentary correspondence from the relatives of residents. The home has undertaken a thorough quality assurance process and evidence was seen of response to issues arising from said survey. There is good nursing support to residents. Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 does not apply) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can be confident that the home undertakes thorough pre admission assessments with relation to people considering moving into the home. EVIDENCE: The home has produced its own assessment forms to go alongside any provided by other professionals before a resident is admitted, which provide a clear basis for thorough assessment covering all of the areas identified in the National Minimum Standards, and additional information to give as complete a picture as possible of the prospective resident’s needs. Additional assessment forms are used for manual handling, continence, environmental risks and medication, which enhance the main assessment form. Visiting community nurse staff undertake risk assessments in relation to tissue viability. Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents, and their representatives, can be confident that the home provides individual plans of care, which set out the needs of residents in relation to their personal and social care needs. Similarly, residents and their representatives can be confident that the home ensures that the health care needs of residents are met, including those relating to the medication needs of residents, and the privacy and dignity of residents is respected by the staff team. EVIDENCE: The inspector examined a sample of care plans, and found them to contain some useful information about how the home intended to meet the assessed needs of individuals. The areas covered related to the pre admission assessments and areas of need identified through ongoing involvement of healthcare professionals, such as pressure area care. The senior staff on duty confirmed that a community nurse visits 3 or 4 times a week and undertakes Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 10 waterlow scores for risk assessing tissue viability, however, the nurse records that identified the levels of risk associated with this area were not available to the inspector as the nurse was not present. Service users fed back to the inspector that the staff at the home were very respectful of the privacy of service users, not intruding unless they had a genuine reason, and always waiting for a response to knocking before entering service users rooms. All of the rooms had en suite facilities. One service user, who spoke to the inspector reported that “I don’t like needing help with my personal needs, but the staff are considerate and polite at all times”. Other residents, and their relatives confirmed that staff always knock before entering rooms. The healthcare needs of residents were well set out in care plans, records were maintained of healthcare appointments and medication prescribed. Medication records were seen and found to be well maintained, without any gaps and entries identifying the dosage given where this was variable. A senior member of staff was able to confirm that the arrangements for service users with terminal illness included regular and continuing visits, extra staff, close monitoring of pain relief, and that staff always attended funerals of service users who had died. The home’s training records confirmed that staff had been given access to training on the care of the terminally ill. Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can be confident that the home provides a wide range of activities on site, based on the expressed preferences of residents, and helps service users engage in these. They can also expect the home to enable residents to maintain regular contact with friends and family. They can also be confident that the home provides care based on the expressed preferences of service users, and allows choice and selfdetermination wherever possible. Residents, and their representatives can be confident that the meals provided at the home are varied and appealing and provided in pleasing surroundings. EVIDENCE: The events folder contained evidence of a wide range of activities, including films, books, religious events, exercise classes, musical evenings, and professional entertainers. A limousine was available for residents and transport for outings was available every Thursday. The deputy manager confirmed that as a result of comments made by residents, a full survey was undertaken in September 2006 of residents preferences in relation to activities and records Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 12 are now maintained of the choices offered to residents and the attendance figures of events to see how successful they were. The activities programme identified on the home’s website identified the range of activities available, these included dinner parties, barbeques, film showings, variety shows, flower arranging sessions, cocktail parties, buffet evenings, open days, themed evenings and monthly exercise classes, massage and reflexology therapy for those who wish to partake. All of the service users interviewed confirmed that they received frequent visits from members of their family, and went on trips out with them on occasions. The home has several areas where private visits can be undertaken, including some small lounges, offices, and service users own bedrooms. Service users rooms contained many personal items belonging to the occupant. Choice in relation to meals was also confirmed, service users stating that the chef came each day to ascertain the choice of each service users in relation to the next day’s meal. Records of menus showed that the meals were varied and always included healthy options. A fish option was available every day Records of the number of relatives who had taken meals at the home clearly showed that the food was popular with guests as well as residents. The senior member of staff on duty was able to confirm that some external training had been provided in the past in relation to nutrition and a list of allergies was displayed in the kitchen. Specialist dietary needs such as gluten or wheat free diets were noted in care plans. Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can expect the rights of residents to be protected through the accessibility of the complaints procedure, and staff’s knowledge of adult protection procedures. EVIDENCE: The home had a robust complaints policy, displayed in the home, and incorporated into the statement of purpose and service user guide. All of the service users who spoke to the inspectors confirmed that they had no reason to complain, but were confident that they could access the procedure if necessary. The examination of the home’s adult protection procedure confirmed that the home had identified the appropriate agency as having the lead responsibility for investigation allegations/suspicions of abuse. The feedback from staff during interview confirmed that they had received training on, and were fully aware of, the principles of adult protection, including the process for reporting concerns, and responding to allegations of possible abuse. Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21 & 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents, and their representatives can confidently expect to experience a high quality environment, inside and out, with suitable equipment and adaptations to facilitate independence and safe levels of hygiene and cleanliness. EVIDENCE: The environment at the home is of the highest quality. Internally, all of the communal areas were furnished with good quality furniture and fittings. The lounges and hallway areas were all decorated to a high standard, and included several side tables, chairs lamps and a number of fresh flower arrangements. The home provides en suite facilities in all bedrooms. The home also provides eight assisted bath/shower rooms in shared areas, and toilet facilities close to dining areas. All of the bedrooms seen at this inspection were spacious, warm Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 15 and well ventilated. On the day of this unannounced inspection, the home was clean and tidy throughout, with no evidence of any unpleasant odours. The home meets all of the national minimum standards for space requirements in relation to bedrooms and communal space. A positive development since the last inspection was the extension of the dining room to accommodate a social bar, which was reported to be highly popular. Externally, the grounds were well maintained, with a variety of lawned areas, patios with outdoor furniture and a variety of ornamental gardens and facilities, such as a summerhouse. The home is located in a rural area and an example of the type of environment was experienced by the inspector who, whilst waiting for the door to be answered, observed a deer running through the front garden area. Records were seen of regular maintenance of equipment, including hoists, water temperature, COSHH, and fire safety equipment. Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Current and prospective service users can be confident that the home recruits staff with service users safety and best interests in mind, and that staff are sufficient in number, and trained to the levels required in order to meet the needs of service users. EVIDENCE: On the day of the inspection there were 5 carers on duty in the morning and 3 in the afternoon/evening. Two waking night staff were employed. Examination of the rotas confirmed that these levels are being maintained. Given the number of service users accommodated, and their dependency levels, these staffing levels are agreed as adequate. The inspector examined the files of four members of staff. All the records required by the Care Homes Regulations 2001 were present in the files. This included a completed application form providing an employment history, references, interview notes and certificates of training. CRB certificates were kept separately, but were present for each of the files examined. Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 17 Staff training records and feedback from staff confirmed that training was routinely provided in relation to fire safety, manual handling and first aid. Records also showed that new staff received inductions to the national training organisation (skills for care) standards. Regular training was also provided in relation to nutrition, continence, dementia care, The senior member of staff on duty had obtained NVQ level 3 in management and had over 15 years experience in this setting. Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Current and prospective service users can be confident that the home is well run by the management team, and is also run in the best interests of service users. The home maintains the health & safety of service users and staff through its policies and practices, along with the staff training programme. EVIDENCE: The deputy manager and building services manager were both near completion of the registered managers award, providing a well-trained senior staff team to complement the registered manager, who had already been assessed as suitably qualified by the Commission for Social Care Inspection. Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 19 The management team had undertaken a full survey of residents views in September 2006, with the results published in a printed format. The buildings manager confirmed that further surveys had been undertaken in response to identified issues, such as activities, with actions taken in response, including the provision of transport to facilitate outings should these be requested. The administrator explained the system used to manage the residents’ personal money. Records were seen of all transactions involving the use of residents personal monies held at the home, and a random sample of monies were counted, all of which tallied with the amounts recorded as being kept by the home on behalf of residents. The home had a comprehensive fire risk assessment, completed in September 2006, following which a visit had been undertaken by a fire safety officer, with no adverse findings. Individual fire risk assessments were in place for each resident’s room and fire safety notices were displayed throughout the building. Training records and service records showed that fire safety training and the testing of equipment was ongoing and regular. Safety records also showed that routine testing and servicing had taken place in relation to substances hazardous to health, the building and grounds, hoists, heating and water, and food safety. Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 3 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations The registered persons should ensure that the home maintains a record of risk assessments completed in relation to individual residents’ possible development of pressure sores. Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Garrett House Residential Home DS0000024394.V334501.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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